19 DYSPNEA General Discussion In its consensus statement, the American Thoracic Society has defined dyspnea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” The experience of dyspnea derives from interactions among multiple physiological, psychological, social, and environmental factors. One of the more popular theories of dyspnea states that dyspnea results from a disassociation or a mismatch between central respiratory motor activity and incoming afferent information from receptors in the airways, lungs, and chest wall structures. The development of shortness of breath is an expected outcome of overexertion, such as occurs after running or heavy lifting. However, when dyspnea occurs at rest or during exertion that is less than expected, it is considered pathologic and a symptom of a disease state. Many patients have a likely cause of dyspnea, such as exacerbation of known congestive heart failure, chronic obstructive pulmonary disease (COPD), or asthma. However, in others the diagnosis may not be readily apparent even after a thorough history and physical examination. The first step in the evaluation of the patient with dyspnea is to determine the status of the patient: (1) distress with unstable vital signs; (2) distress with stable vital signs; or (3) no distress and stable vital signs. The next step in the evaluation of patients with dyspnea is to establish the primary organ system involved: pulmonary, cardiac, both, or neither. In the elderly patient, dyspnea is generally due to one of five major etiologies: (1) cardiac disease, (2) respiratory disease, (3) deconditioning/obesity, (4) respiratory muscle dysfunction, or (5) psychological disorders. The patient’s age, comparison with peers, daily or usual activities, overall fitness level, and any other medical problems must be considered. In most patients, the cause or causes of dyspnea can be determined by using the history and physical examination to identify common etiologies, particularly cardiac and pulmonary causes. In some cases, specific diagnostic testing or consultation may be required to establish or confirm the diagnosis. Medications Associated with Dyspnea Amiodarone (pneumonitis) Aspirin overdose Beta blockers (may aggravate obstructive airway disease) Nitrofurantoin (pneumonitis) Causes of Dyspnea Cardiac causes • Arrhythmia • Asymmetric septal hypertrophy • Congestive heart failure • Coronary artery disease • Myocardial infarction • Pericardial disease • Valvular disease Metabolic and endocrine causes • Carbon monoxide poisoning • Metabolic acidosis • Salicylate poisoning • Thyroid disease • Uremia Medications Neuromuscular causes • Amyotrophic lateral sclerosis • Guillain–Barré syndrome • Myasthenia gravis Psychogenic causes • Anxiety • Depression • Hyperventilation • Panic attacks • Post-traumatic stress disorder • Secondary gain/malingering • Somatization disorder Pulmonary causes • Asbestosis • Aspiration (may be due to gastroesophageal reflux disease) • Asthma • Berylliosis • Bronchiectasis • COPD • Coal workers’ lung • Hypersensitivity pneumonitis • Malignancy (primary or metastatic) Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on DYSPNEA Full access? Get Clinical Tree
19 DYSPNEA General Discussion In its consensus statement, the American Thoracic Society has defined dyspnea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” The experience of dyspnea derives from interactions among multiple physiological, psychological, social, and environmental factors. One of the more popular theories of dyspnea states that dyspnea results from a disassociation or a mismatch between central respiratory motor activity and incoming afferent information from receptors in the airways, lungs, and chest wall structures. The development of shortness of breath is an expected outcome of overexertion, such as occurs after running or heavy lifting. However, when dyspnea occurs at rest or during exertion that is less than expected, it is considered pathologic and a symptom of a disease state. Many patients have a likely cause of dyspnea, such as exacerbation of known congestive heart failure, chronic obstructive pulmonary disease (COPD), or asthma. However, in others the diagnosis may not be readily apparent even after a thorough history and physical examination. The first step in the evaluation of the patient with dyspnea is to determine the status of the patient: (1) distress with unstable vital signs; (2) distress with stable vital signs; or (3) no distress and stable vital signs. The next step in the evaluation of patients with dyspnea is to establish the primary organ system involved: pulmonary, cardiac, both, or neither. In the elderly patient, dyspnea is generally due to one of five major etiologies: (1) cardiac disease, (2) respiratory disease, (3) deconditioning/obesity, (4) respiratory muscle dysfunction, or (5) psychological disorders. The patient’s age, comparison with peers, daily or usual activities, overall fitness level, and any other medical problems must be considered. In most patients, the cause or causes of dyspnea can be determined by using the history and physical examination to identify common etiologies, particularly cardiac and pulmonary causes. In some cases, specific diagnostic testing or consultation may be required to establish or confirm the diagnosis. Medications Associated with Dyspnea Amiodarone (pneumonitis) Aspirin overdose Beta blockers (may aggravate obstructive airway disease) Nitrofurantoin (pneumonitis) Causes of Dyspnea Cardiac causes • Arrhythmia • Asymmetric septal hypertrophy • Congestive heart failure • Coronary artery disease • Myocardial infarction • Pericardial disease • Valvular disease Metabolic and endocrine causes • Carbon monoxide poisoning • Metabolic acidosis • Salicylate poisoning • Thyroid disease • Uremia Medications Neuromuscular causes • Amyotrophic lateral sclerosis • Guillain–Barré syndrome • Myasthenia gravis Psychogenic causes • Anxiety • Depression • Hyperventilation • Panic attacks • Post-traumatic stress disorder • Secondary gain/malingering • Somatization disorder Pulmonary causes • Asbestosis • Aspiration (may be due to gastroesophageal reflux disease) • Asthma • Berylliosis • Bronchiectasis • COPD • Coal workers’ lung • Hypersensitivity pneumonitis • Malignancy (primary or metastatic) Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on DYSPNEA Full access? Get Clinical Tree
